Lung cancer rates convergence in young men and women in the United States: analysis by birth cohort and histologic type

Age-specific rates of lung cancer have been consistently higher for men than for women in the United States, due primarily to different patterns of cigarette smoking. Gender differences in cigarette smoking have diminished in recent birth cohorts, however, especially among whites. We used U.S. population-based incidence and mortality data and examined trends in age-specific rates of lung cancer by birth cohort according to gender, ethnic group, and histology to evaluate the generational changes in U.S. lung cancer risk for men vs. women. All tests of statistical significance are 2-sided (95% confidence interval [CI]). Lung cancer mortality rates have converged between men and women born after 1960, especially in whites. The male-to-female (M:F) mortality rate ratio for ages 35-39 years decreased from 3.0 (95% CI = 2.7-3.4) around the 1915 birth cohort to 1.1 (95% CI = 1.0-1.1) around the 1960 birth cohort among whites and from 4.0 (95% CI = 3.2-5.0) around the 1925 birth cohort to 1.5 (95% CI = 1.3-1.7) around the 1960 birth cohort among blacks. Similarly, incidence rates for white men and women converged rapidly for adenocarcinoma, small cell carcinoma, and large cell carcinoma, but less so for squamous cell carcinoma. These findings reflect the smoking patterns among white and black men and women: cigarette smoking prevalence at age 24 was essentially equal among white men and women born after 1960 but continued to be higher in black men than women. The convergence of lung cancer death rates among men and women born after 1960s supports the idea that males and females maybe equally susceptible to develop lung cancer from a given amount of cigarette smoking, rather than the hypothesis that women are more susceptible.